본문 바로가기
KERD
논문KCI 등재

건강검진 자료를 이용한 나이관련황반변성의 위험인자 분석

Analyses of Risk Factors of Age-related Macular Degeneration Using Routine Health Check-up Data

김홍규|한동균
대한안과학회 (The Korean Ophthalmological Society)|2021.01|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제1호|pp. 46-54

1

조회

0

다운로드

1

인용

0

참고문헌

키워드

Risk factorAge-related macular degenerationFundus photographyCheck-up
주제분류안과학

초록

목적: 건강검진 자료를 분석하여 나이관련황반변성의 위험인자를 찾고자 하였다. 대상과 방법: 2017년 1월부터 12월까지 1년 동안 한국의 지역사회 단일기관의 건강검진 센터에서 건강검진을 시행한 40세 이상의 성인 9,019명 중 안저사진촬영을 시행하지 않았거나 검사영상의 질이 좋지 않아 판독이 부정확한 2,001명을 제외한 성인 7,018명을 대상으로 연구를 진행하였다. 결과: 총 7,018명의 40세 이상인 성인 중 나이관련황반변성이 발견된 환자는 183명이었고 이 중 초기가 104명, 중기 75명, 후기 4명이었다. 대조군과 나이관련황반변성 세 군, 총 네 군은 일원배치 분산분석상 그룹 간 유의한 나이 차이를 보였다. 성향점수 매칭으로 나이와 성별을 보정한 후 나이관련황반변성이 환자군과 대조군 사이에 혈압, 체질량지수, 몸무게에 차이를 보이지 않았으나 B형간염표면항원, 알카라인 포스파타제, 혈소판, 적혈구 침강률, 감마 글루타밀전이효소, 고밀도지단백, 암배아항원, C반응단백, 음주, 흡연, 운동 여부에 유의한 차이를 보였다. 관련성을 보인 인자를 이용하여 다중 로지스틱 회귀분석을 시행한 결과 B형간염 표면항원이 양성이고, C반응단백, 고밀도지단백, 암배아항원 수치가 상승했으며, 운동을 하지 않고, 현재 흡연을 하는 사람에게 나이관련황반변성의 위험성이 높았다. 결론: 본 연구는 건강검진 자료를 이용하여 나이관련황반변성의 위험인자를 분석했고 혈액검사상 B형간염 표면항원의 양성, 상승된 C반응단백, 고밀도지단백, 암배아항원 수치, 운동의 결핍, 현재의 흡연에 위험성이 커진다.

Abstract

Purpose: To investigate risk factors of age-related macular degeneration (AMD) with routine health check-up data. Methods: Among 9,019 patients older than 40 years who underwent a routine health checkup at a single institution of South Korea from January to December 2017, 7,018 patients were enrolled in this retrospective study. An additional 2,001 patients were accepted. due to the absence of a fundus photo or having a fundus photo of poor quality. Results: Among 7,018 patients, 183 patients were diagnosed with AMD. We diagnosed 104 patients with early-phase, 75 patients with intermediate-phase, and 4 patients with late-phase AMD. The AMD groups were compared to a control group using one-way analysis of variance. The control, early, and intermediate groups showed meaningful differences with respect to age. In propensity score matching for age and sex, no differences were observed with respect to blood pressure, body mass index, or weight; however, significant differences were evident for the parameters of hepatitis B surface antigen, alkaline phosphatase, platelet, erythrocyte sedimentation rate, gamma glutamyl transferase, high density lipoprotein (HDL), carcinoembryonic antigen (CEA), C-reactive protein (CRP), status of exercise, drinking, and smoking between the control and AMD groups. In multiple logistic regression analyses with relevant factors, a strong positive relationship was established for hepatitis B surface antigen, HDL, CRP and CEA elevation, absence of exercise, and current smoking in AMD patients. Conclusions: Risk for AMD was strongly correlated with hepatitis B surface antigen, elevation of HDL, CEA and CRP in blood tests, the absence of exercise, and a history of smoking.

참고문헌 (47)

  1. Wong WL, "Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040 : a systematic review and meta-analysis", Lancet Glob Health, 2, pp.e106~e116 (2014)
  2. Bird AC, "An international classification and grading system for age-related maculopathy and agerelated macular degeneration. The International ARM Epidemiological Study Group", Surv Ophthalmol, 39, pp.367~374 (1995)
  3. Klein R, "The Wisconsin age-related maculopathy grading system", Ophthalmology, 98, pp.1128~1134 (1991)
  4. Lengyel I, "Association of drusen deposition with choroidal intercapillary pillars in the aging human eye", Invest Ophthalmol Vis Sci, 45, pp.2886~2892 (2004)
  5. Mullins RF, "Choriocapillaris vascular dropout related to density of drusen in human eyes with early age-related macular degeneration", Invest Ophthalmol Vis Sci, 52, pp.1606~1612 (2011)
  6. Spaide RF, "Disease expression in nonexudative age-related macular degeneration varies with choroidal thickness", Retina, 38, pp.708~716 (2018)
  7. Corvi F, "Choroidal structure in eyes with drusen and reticular pseudodrusen determined by binarisation of optical coherence tomographic images", Br J Ophthalmol, 101, pp.348~352 (2017)
  8. Grewal DS, "A pilot quantitative study of topographic correlation between reticular pseudodrusen and the choroidal vasculature using en face optical coherence tomography", PLoS One, 9, pp.e92841~ (2014)
  9. Querques G, "Choroidal changes associated with reticular pseudodrusen", Invest Ophthalmol Vis Sci, 53, pp.1258~1263 (2012)
  10. Arnold JJ, "Reticular pseudodrusen. A risk factor in age-related maculopathy", Retina, 15, pp.183~191 (1995)
  11. Zweifel SA, "Prevalence and significance of subretinal drusenoid deposits(reticular pseudodrusen)in age-related macular degeneration", Ophthalmology, 117, pp.1775~1781 (2010)
  12. Lee J, "Drusen subtypes and choroidal characteristics in Asian eyes with typical neovascular age-related macular degeneration", Retina, 40, pp.490~498 (2020)
  13. Age-Related Eye Disease Study Research Group, "A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss", Arch Ophthalmol, 119, pp.1417~1436 (2001)
  14. Jager RD, "Age-related macular degeneration", N Engl J Med, 358, pp.2606~2617 (2008)
  15. Kawasaki R, "The prevalence of age-related macular degeneration in Asians : a systematic review and meta-analysis", Ophthalmology, 117, pp.921~927 (2010)
  16. Yang K, "Prevalence of age-related macular degeneration in a rural Chinese population : the Handan Eye Study", Ophthalmology, 118, pp.1395~1401 (2011)
  17. Park SJ, "Age-related macular degeneration : prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011", Ophthalmology, 121, pp.1756~1765 (2014)
  18. Ishiko S, "Detection of drusen in the fellow eye of Japanese patients with age-related macular degeneration using scanning laser ophthalmoscopy", Ophthalmology, 109, pp.2165~2169 (2002)
  19. 송인석, "안저사진과 레트로모드로 촬영한 주사레이저검안경 영상의 드루젠 발견 비교", 대한안과학회지, 52(10), pp.1189~1194 (2011), 대한안과학회
  20. Friedman DS, "Prevalence of age-related macular degeneration in the United Stated", Arch Ophthalmol, 122, pp.564~572 (2004)
  21. Age-Related Eye Disease Study Research Group, "Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3", Ophthalmology, 107, pp.2224~2232 (2000)
  22. Delcourt C, "Smoking and age-related macular degeneration. The POLA Study", Arch Ophthalmol, 116, pp.1031~1035 (1998)
  23. Esparza-Gordillo J, "Genetic and environ-mental factors influencing the human factor H plasma levels", Immunogenetics, 56, pp.77~82 (2004)
  24. Kahn HA, "The Framingham Eye Study. II. Association of ophthalmic pathology with single variables previously measured in the Framingham Heart Study", Am J Epidemiol, 106, pp.33~41 (1977)
  25. Klein R, "The relation of cardiovascular disease and its risk factors to the 5-year incidence of age-related maculopathy : the Beaver Dam Eye Study", Ophthalmology, 104, pp.1804~1812 (1997)
  26. Cougnard-Grégoire A, "Longterm blood pressure and age-related macular degeneration : the ALIENOR study", Invest Ophthalmol Vis Sci, 54, pp.1905~1912 (2013)
  27. Hogg RE, "Cardoivascular disease and hypertension are strong risk factors for choroidal neovascularization", Ophthalmology, 115, pp.1046~1052 (2008)
  28. Chen SJ, "Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan", Invest Ophthalmol Vis Sci, 49, pp.3126~3133 (2008)
  29. 노미인, "Estimated Prevalence and Risk Factor for Age-related Maculopathy", Yonsei Medical Journal, 49(6), pp.931~941 (2008), 연세대학교의과대학
  30. Knudtson MD, "Alcohol consumption and the 15-year cumulative incidence of age-related macular degeneration", Am J Ophthalmol, 143, pp.1026~1029 (2007)
  31. Knudtson MD, "Physical activity and the 15-year cumulative incidence of age-related macular degeneration : the Beaver Dam Eye Study", Br J Ophthalmol, 90, pp.1461~1463 (2006)
  32. McGuinness MB, "Physical activity and age-related macular degeneration : a systematic literature review and meta-analysis", Am J Ophthalmol, 180, pp.29~38 (2017)
  33. Gopinath B, "Physical activity and the 15-year incidence of age-related macular degeneration", Invest Ophthalmol Vis Sci, 55, pp.7799~7803 (2014)
  34. Wu CM, "Association of chronic hepatitis B virus infection with age-related macular degeneration", Acta Ophthalmol, 97, pp.e713~e718 (2019)
  35. Friberg TR, "Hepatitis B surface antigen in human subretinal fluid", Am J Ophthalmol, 95, pp.712~713 (1983)
  36. Temel A, "Detection of hepatitis B surface antigen in aqueous humor", Acta Ophthalmol(Copenh), 68, pp.205~208 (1990)
  37. Köksal I, "Hepatitis B surface antigen in tears and aqueous humor. A comparative study of serum hepatitis B surface antigen levels", Ophthalmologica, 204, pp.19~22 (1992)
  38. Singh VK, "Molecular mimicry between a uveitopathogenic site of S-antigen and viral peptides. Induction of experimental autoimmune uveitis in Lewis rats", J Immunol, 144, pp.1282~1287 (1990)
  39. Slepova OS, "Clinical and immunological signs of retinal lesions and possibilities of their correction by drugs in patients with chronic diffuse liver diseases of viral etiology and carriers of Australia antigen", Vestn Oftalmol, 110, pp.27~29 (1994)
  40. Chou RH, "HBV infection increases the risk of macular degeneration : the roles of HBx‑mediated sensitization of retinal pigment epithelial cells to UV and blue light irradiation", J Transl Med, 16, pp.221~ (2018)
  41. Abulude OA, "Assessment of Hepatitis B Viral infection as a predictor of hepatic enzymes and compounds alteration among antenatal patients", Med Sci(Basel), 5, pp.24~ (2017)
  42. Johnson PT, "Individuals homozygous for the age-related macular degeneration risk-conferring variant of complement factor H have elevated levels of CRP in the choroid", Proc Natl Acad Sci USA, 103, pp.17456~17461 (2006)
  43. Dewan A, "Two genetic pathways for age-related macular degeneration", Curr Opin Genet Dev, 17, pp.228~233 (2007)
  44. Perkins SJ, "Complement factor H-ligand interactions : self-association, multivalency and dissociation constants", Immunobiology, 217, pp.281~297 (2012)
  45. Sengul EA, "Correlation of neutrophil", lymphocyte and platelet, Int J Ophthalmol, pp.2017, 10[DOI]
  46. 오상철, "종양 표지자의 임상적 유용성", 대한내과학회지, 83(2), pp.197~199 (2012), 대한내과학회[DOI]
  47. 정소이, "False-positive Elevations in Carcinoembryonic Antigen Levels at a Health Screening Center", Laboratory Medicine Online, 9(3), pp.146~152 (2019), 대한진단검사의학회[DOI]

관련 논문AI추천

Estimated Prevalence and Risk Factor for Age-related Maculopathy고형준, 권오웅, 김지현, 노미인, 변석호, 이성철연세대학교의과대학 · Yonsei Medical Journal2008 · 제49권 제6호폐경기 여성에서 나이관련황반변성과 여성 호르몬 요인과의 관계: 제5기 국민건강영양조사 자료백승국, 이영훈대한안과학회 · 대한안과학회지2017 · 제58권 제9호한국인 60세 이상 노년층의 황반변성과 백내장의 위험요인 -국민건강보험공단 노인코호트 자료를 활용하여-박윤숙, 박해용, 이은희한국융합학회 · 한국융합학회논문지2017 · 제8권 제10호습성 나이관련황반변성으로 진단된 90세 이상 초고령 환자의 특성김재휘, 김종우, 김철구, 이동원, 이윤곤, 한상윤, 한재욱대한안과학회 · 대한안과학회지2018 · 제59권 제5호맥파 속도와 상완-발목 지수의 조기연령관련 황반변성 예측인자로서의 유용성김상수, 박정민, 장정현대한안과학회 · 대한안과학회지2011 · 제52권 제6호단안 삼출성 나이관련황반변성 환자의 무증상 반대안의 외망막층 두께 변화김성수, 박현주, 정현교대한안과학회 · 대한안과학회지2017 · 제58권 제9호

이 간행물의 다른 논문 (19건)

나이와 크기에 따른 콩다래끼 병소 내 스테로이드 국소주사의 치료 효과 비교송도윤, 노주헌pp. 1-5비대칭 눈썹을 가진 노년 상안검 안검하수 환자에서 안검하수수술 후 눈썹의 위치 변화김남영, 안희배, 조희정pp. 6-11각막이식 실패를 초래하는 고위험군에 대한 조사고병이, 김영준, 정호석, 정태영, 이용민, 차흥원, 현준영, 권혜지, 김현승pp. 12-20건성안 증상을 가지는 환자들에서 각막 통각과민 환자의 임상양상김태훈, 한경은pp. 21-28국내에서 상품화된 안검 온열 안대의 안검 가열 효과 비교김효명, 엄영섭, 황진영, 최수연, 송종석pp. 29-35
원문 보기